Venous thromboembolism in elective operations: balancing the choices

Venous thromboembolism (VTE) is a recognized cause of morbidity and mortality in hospitalized patients and is reported to account for 250,000 deaths annually. Recent shifts in prophylaxis administration are occurring among surgical specialty groups after observing a lower rate of VTE among patients undergoing elective operation. We report the incidence of VTE from 3 sources to provide an estimate of the true risk of the complication in elective surgery.

Data from the Surgical Care Improvement Project (SCIP), University HealthSystem Consortium (UHC), and Kentucky Cabinet for Health and Family Services (CHFS) databases were queried for 2004 for the same operative patient groups.

Of 5,285 operations performed within SCIP 2004, the incidences of deep venous thrombosis (DVT) and pulmonary embolus (PE) were 0.4% and 0.3%, respectively, with no reported deaths. Of 966,474 operations recorded in the UHC 2004 data, rates of DVT and PE were 1.2% and 0.5%, respectively. The incidence rates of DVT and PE among 20,563 patients in the CHFS 2004 database were 0.5% and 0.3%, respectively, and included 3 deaths.

VTE and associated mortality rates are extremely low in these 3 large data sources. We believe patients will benefit from an ongoing assessment of real need and complications of carefully risk-adjusted VTE prophylaxis.